Provider Demographics
NPI:1407934540
Name:VAN DUINEN, ROGER SCOTT (OTR)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:SCOTT
Last Name:VAN DUINEN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 JACKSON SQ
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2458
Mailing Address - Country:US
Mailing Address - Phone:864-226-2247
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2067
Practice Address - Country:US
Practice Address - Phone:864-261-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1618225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist